To the Editor.
—The excellent article by Cohen et al1 does much to dispel fears about the risks of lithium carbonate during pregnancy. We would like to point out that in addition to carbamazepine, valproate sodium, and neuroleptics, electroconvulsive therapy (ECT) should be considered as an antimanic and antidepressant treatment during pregnancy. In fact, most experts consider ECT to be safer for the fetus than many psychotropic medications,2 and there is an extensive literature documenting the safe and effective use of ECT in all three trimesters.3 The brief exposure to the anesthetic and muscle relaxant agents during ECT is likely to be more benign than constant exposure to (even slightly) teratogenic psychotropic medications. For severely depressed or manic pregnant women, ECT should be considered seriously.
Kellner CH, Beale MD, Pritchett JT. The Risk of In Utero Exposure to Lithium. JAMA. 1994;271(23):1828. doi:10.1001/jama.1994.03510470032024